DIAGNOSIS from the homoeopathic standpoint is arduous, many- angled and essentially individual. It is concerned with the person who is sick rather than with the “disease label” that can be attached to his symptoms.
Robert Platt is quoted as saying in 1947 : “It has seemed to me for a long time that good doctors differ from bad ones in two major respects. The time they devote to history-taking and their ability to interpret a history correctly is the first. The second is their ability to formulate a plan of treatment. I know that I am not alone in thinking that history-taking is the greatest art in medicine”.
A.Hughes, in the Lancet in 1951 wrote : “A history has to be taken-a more difficult, skilled, and accurate diagnostic measure than all the chemical and electrical paraphernalia in use today- and then the patient has to be examined. In these two procedures lie the knowledge, experience, judgement and art of medicine.”
Accurate and painstaking history-taking is at the very heart of the homoeopathic approach for only so can the all-important details of the particular illness and the individual characteristics of the particular patient be arrived at, matters essential for the selection of the Similar Remedy.
In the first place every effort should be made to discover as far as possible what is going on, and what is going wrong, in the body of the sick man; what organs are diseased, what functions are deranged, what tissues are damaged or disordered.
These are pertinent questions, and the answers to them, when available, may reveal a need for surgical, dietetic, supportive, or substitutionary treatment.
It has to be admitted that only too often the best that can be arrived at in this matter of a pathological diagnosis is liable to be inadequate or inaccurate, or both; part of the truth but far from being the whole. Partial truth can be very misleading and is but a poor guide to treatment of the underlying disorder responsible for the symptoms.
Such lesions as can be observed and such findings as can be detected, are often but the end results of a widespread disorder that must be corrected if there is to be any hope of “cure”.
This does not provide any justification for by passing the provisional pathological diagnosis. Nevertheless the risk of being over engrossed in the “part” to the neglect of the “whole” must always be borne in mind.
A careful physical examination must not be omitted, and any X- ray or other investigation must be carried out when relevant and in the genuine interests of the patient.
Knowledge of underlying pathology in addition to possibly pointing to the need for surgical or other ancillary measures, may be of assistance to the homoeopath because of his knowledge of “tissue affinities”. As mentioned in the preceding chapter, the relation of certain remedies to specific organs or tissues may be of significance for therapy when such organs or tissues are known to be involved in the disease process.
Attention must first be paid to the particular Symptoms of which the patient complains, both in relation to the present illness and also any other troubles. The latter may be considered of minor importance by the patient but may well be of signal significance in remedy selection.
It is necessary to listen, as far as possible without interruption, to the patient’s story, listing the more relevant items. While so doing, observation can be made in relation to the following :
Posture : A patient sitting tense and erect on the edge of the chair suggests ARSENICUM ALBUM;
One who flops into the chair and lounges at full length, omitting perhaps to remove his hat, might point to SULPHUR;
Sit there wringing her hands, probably IGNATIA or PHOSPHORUS;
Constant movements, especially of the feet, suggest the possibility of ZINCUM METALLICUM.
Manner : Excited, suggests PHOSPHORUS; apathetic, points to SEPIA; obviously holding back tears, likely to be NATRUM MURIATICUM; haughty and disdainful, indicates PLATINA.
Complexion : Blazing red visage points to BELLADONNA; quick changes of colour would suggest IGNATIA; pallor of lips, ears and fingers would indicate CALCAREA CARBONICA; and so on.
Expression : A scared panicky look points to ACONITUM; a furtive glint in the eye suggests LACHESIS; a bashful, bored appearance may indicate BARYTA CARBONICA; a deep furrow above the root of the nose typifies LYCOPODIUM.
Hair : Dry, lustreless hair would suggest several remedies, among them MEDORRHINUM and PSORINUM; sleek well-kept hair might point to ARSENICUM ALBUM; alopecia areata would suggest PHOSPHORUS; strikingly red lips would point to TUBERCULINUM.
Speech : This is especially worthy of note; a spate of words, uttered rather disjointedly, jumping from subject, to subject, points to LACHESIS; pointificating conversation in the manner of the club bore strongly suggests SULPHUR; readiness to reply with, perhaps, some hesitation for the sake of accuracy indicates PHOSPHORUS.
Clothes : May suggest ARSENICUM ALBUM if strikingly smart and neat; the reverse, a somewhat untidy, unkempt look would point to SULPHUR. Odour : An offensive body odour would suggest MERCURIUS, or PSORINUM; a sour smell of discharges or stools would point to CALCAREA CARBONICA; a pungent cadaverous odour would suggest BAPTISIA; a particularly foul odour would point to CARBO VEGETABILIS or PSORINUM.
The remedies mentioned are just a few examples from the materia medica.
But to return to the patient’s story, further questioning must be made to elicit the details of the symptoms. These are all- important.
Details as to the onset and course of the illness. A sudden onset and rapid development point to ACONITUM or BELLADONNA. Insidious onset and gradual progress suggest BRYONIA, GELSEMIUM or PULSATILLA.
Enquiry must include any possible cause of illness, either recent or remote. The aetiological factor can be of considerable importance as pointing to a definite remedy.
A history of illness coming on quickly after exposure to severe dry cold would suggest ACONITUM; illness ensuing after getting chilled when hot would probably require DULCAMARA; effects of loss of sleep might point to COCCULUS; a history of head injury, perhaps remote, would suggest NATRUM SULPHURICUM; and so on.
Again the character of the pain or other symptom must be enquired into, the sort of pain, the site, the spread, the severity and above all the sensibilities or modalities.
The modalities as mentioned in the preceding chapter are of special significance and often enable the choice to be made between two quite strongly indicated remedies, indicated on other features of the case.
A further aspect sometimes comes into consideration, namely laterality. It so happens that many remedies show a relation to symptoms which are predominantly either right-sided or left-sided or spread in a characteristic manner. For instance :
Symptoms starting on the right side and spreading to the left point to LYCOPODIUM; those starting on the left and extending to the right indicate LACHESIS; symptoms which shuttle from side to side point to LAC CANINUM; pain shooting centrally up a limb points to HYPERICUM; pain shooting down the limb indicates KALMIA; pain spreading in all directions points to DIOSCOREA.
It goes without saying that enquiry must be made as to previous illness, including any treatments given, and also into family history. Indications may arise in these connections for selection of a remedy related to remote causes of illness or possibly an inherited diathesis.
Enquiry into the patient’s background, may be of primary significance in relation to the present illness, namely experiences during childhood, schooldays and after, both social and occupational. In some cases even pre-natal experiences undergone by the mother during pregnancy may provide indications for selection of a special remedy in relation to illness developed in infancy or later.
Enquiries of this kind, whether reached in the first interview or later, are essential to the handling of the case. This is especially so in dealing with the more chronic or long-standing type of illness, for the sick person must be treated in relation to all his or her circumstances and surroundings and not merely as a case of this or that per diagnostic label.
Adjustment to circumstances or alteration in habits or attitudes may be called for in addition to the prescribing of suitable medicine.
From the angle of homoeopathic prescribing it is often helpful to assess the constitutional make-up of the patient. To this end enquiry should be made into matters referred to under physiology and modalities in the preceding chapter.
Individual traits in relation to appetite, food likes, dislikes and intolerances, thirst, sweating and sleep often afford useful information. As do also the general responses to environmental influences, thermal, meteorological and so on.
Important as it is to size up the patient from the temperamental and psychological standpoint it is best to leave enquiry along these lines till the patient’s confidence has been gained by the obvious interest and concern evidenced in the preceding lines of enquiry.
Some estimate of the patient’s personality and temperament has probably been arrived at already but further tactful enquiry may be called for into such matters as fears, tears, temper, tidiness or otherwise, ability to relax or the reverse, response to sympathy, attitude to heights or closed spaces, interests and hobbies, and so on.
Outstanding psychological features will often provide a strong indication for the use of one or another remedy.
By careful comparison of the outstanding features of the patient’s total symptom-picture with the characteristic features of drug-pictures in the materia medica one or more similar remedies will be suggested, thus arriving at a tentative prescribing diagnosis.
The similarity may be so striking and so clear that the remedy is obvious and can be prescribed straight away. But often there will be more than one remedy indicated at this point. Further consideration is necessary before the final choice can be made.
Of immense value in this connection is a further step, to discover the typological, or constitutional, diagnosis. Individuals vary greatly in their constitutional make-up and what is important is the known relation of remedies to fairly well- defined types. There are often clearly revealed by the physical features, the mental and emotional attributes and the general reactions that have been brought to light.
Hahnemann’s Three “Miasms”.
There remains still another line of diagnosis to be followed up, namely the toxicotic. As Hahnemann emphasised more and more in his later writings the most important factor both in initiating and in maintaining disease is probably the presence in the tissues of poisons, “miasms” as he called them, toxins as we would say today.
With the limited facilities for research available in his day Hahnemann’s search for such disease-producing poisons or miasms was extremely restricted.
He postulated three main miasms as causal in initiating and prolonging disease states. These be named Psora, especially related to congestive states and cutaneous manifestations; Sycosis, especially related to catarrhal states; and Syphilis, then as now a widespread human scourge and responsible for a variety of disease manifestations.
Much is now known as to the toxicotic causation on disease, and it is realised that chronic disease may be due to residual poisoning from previous infections such as diphtheria, measles, scarlet fever, tuberculosis, typhoid fever and malaria, to say nothing of the aftermath of vaccination and various inoculations.
The reason why such knowledge is of special value to the homoeopath is that in his materia medica he possesses remedies that are specially related to the different forms of toxicosis, not only to Hahnemann’s “Big Three” but also to many others.
For instance : NATRUM MURIATICUM is related to malaria; MERCURIUS to syphilis; DROSERA to tuberculosis; and THUJA to vaccinosis.
Other remedies derived from disease tissue or from culture of specific organisms are called “nosodes” (nosos-disease).
These are of special value in prolonged disease when the apparently indicated remedy fails to clear up the case, and also in chronic disease states apparently deriving from some infective episode, perhaps many year in the past. They may also be employed prophylactically.
Nosodes are prepared by the process of attenuation and sub- division described in the next chapter. The toxicity of the original material is thus neutralised and replaced by curative power, the ability to stimulate antitoxic and restorative activity in the tissues of the body.
The exact mode of action of the remedy is still unknown. the actual presence of so-called toxins in the body is also only a partial hypothesis. It is, nevertheless, evident that much chronic disease does derive from previous infection, sometimes antenatal. The re-resulting condition of metabolic disharmony or of tissue sensitivity calls for the use of a deeply acting remedy related to the causal factor.
The foregoing may seem a somewhat formidable undertaking at first sight. The scheme may be regarded as a sort of blueprint for history-taking which can be modified according to circumstances and as the result of experience.
In an acute emergency, decision will obviously have to be reached as to treatment on a quick assessment of the immediate features of the case. But often a satisfactory line of therapy can only be decided after a full and meticulous review of all the facts, as outlined above.
For the homoeopath diagnosis is no light or easy task. In addition to the search for clues to underlying pathology, which is the obligation of every physician, he must also track down the curative similar remedy from every possible angle-causal factor, symptom-picture, constitutional type and deep-seated toxicosis, or miasm.